PATENT APPLICATION FEE DETERMINATION RECORD
Effective October 1 , 2003
Application orOocket Number
CLAIMS AS FILED - PART I
TOTAL CLAIMS
FOR
NUMBER FILED
NUMBER EXTRA
TOTAL CHARGEABLE CLAIMS
~~H9 minus 20=
: *9
INDEPENDENT CLAIMS
^minus 3 =
MULTIPLE DEPENDENT CLAIM PRESENT
□
* If the difference in column 1 is less than zero, enter "0° in column 2
CLAIMS AS AMENDED - PART II
(Column 1)
(Column 2)
(Column 3)
ENTA
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
2
a
z
Total
• s?
Minus
« V?
UJ
2
Independent
■ H
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
i i
(Column 1)
(Column 2)
(Column 3)
ENTB
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAIO FOR
PRESENT
EXTRA
S
o
z
Total
• 3V
Minus *
- H>
UJ
s
Independent
■ H
Minus
~ .<;
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
□
(Column 1)
(Column 2)
fColumn 3)
ENTC
CLAIMS
REMAINING
. AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
S
a
z
Total
*
Minus
**
UJ
Independent
*
Minus
*+*
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
SMALL ENTITY
TYPE
OTHER THAN
OR SMALL ENTITY
RATE
FEE
RATE
FEE
BASIC FEE
385.00
OR
BASIC FEE
770.00
XS9=
OR
XS18=
X43=
OR
X86=
•t-145=
OR
+290=
TOTAL
OR
TOTAL
• tt the entry In column t is less than the entry in column 2, write TT in column 3.
- If the "Highest Number Previously Paid For IN THIS SPACE is less than 20. enter "20." add]t"fff
—If the 'Highest Number Previously Paid For* IN THIS SPACE Is less than 3, enter *3 *
OTHER THAN
SMALL ENTITY
OR
SMALL ENTITY
ADDI-
ADDI-
RATE
TIONAL
FEE
RATE
TIONAL
FEE
XS 9=
OR
X$18=
X43=
OR
X86=
+ 145=
OR
+290=
TOTAL
"OR
TOTAL
ADDIT. FEE
ADDIT. FEE
ADDI-
ADDI-
RATE
TIONAL
* FEE
RATE
TIONAL
FEE
XS 9=
OR
X$18=
X43=
OR
X86=
+145=
OR
+290=
»
TOTAL
nc7 TOTAL
wri AnniT pff
ADDI-
ADDI-
rate;
TIONAL
FEE .
RATE
TIONAL
FEE
X$ 9=
OR
X$18=
X43=
OR
X86=
+145=
OR
+290=
TOTAL
ADDIT FFF
nn TOTAL
my
The 'Highest Number Previously Paid For* (Total or Independent) is the highest number found in the appropriate box in column t.
FOflMPTO*75 (Rev. 10/031
Patent and Trademark Office; y.S. DEPARTMENT OF COMMERCE